Aneurysm Surgery with Preoperative Three-Dimensional Planning in a Virtual Reality Environment: Technique and Outcome...

Area of Science:

• Neurosurgery
• Medical Imaging
• Virtual Reality

Background:

• Aneurysm surgery requires precise spatial understanding of complex vascular anatomy.
• Preoperative planning is crucial for successful clipping procedures.

Purpose of the Study:

• To evaluate the outcomes of aneurysm clipping procedures planned using a virtual reality (VR) workstation over a decade.
• To assess the impact of VR planning on mortality, morbidity, and aneurysm occlusion rates.

Main Methods:

• 115 intracranial aneurysms in 105 patients were preoperatively planned using the Dextroscope VR system between 2006 and 2015.
• Outcome data from three institutions were analyzed retrospectively.
• Cases included both incidental, unruptured aneurysms and those in patients with prior subarachnoid hemorrhage.

Main Results:

• For elective clipping of unruptured aneurysms (n=85), mortality was 0%, morbidity (mRS>2) was 2.6%, and complete occlusion was 91.8%.
• For aneurysms in patients with prior subarachnoid hemorrhage (n=30), mortality was 3.6%, morbidity was 7.1%, and complete clipping was 90%.
• VR planning facilitated clip preselection, positioning, and anticipation of surgical challenges.

Conclusions:

• Meticulous 3D surgical planning in VR enhances spatial comprehension of vascular anatomy.
• VR planning is associated with excellent clinical outcomes and high rates of complete aneurysm closure.
• This multi-institutional series demonstrates VR planning's efficacy in aneurysm clipping surgery.